Grunya Efimovna Sukhareva - the woman who defined autism
Sukhareva was the first to publish a detailed description of autistic traits (symptoms) in 1925. You read that right, 1925.
Meet the child psychiatrist Grunya Efimovna Sukhareva ( Груня Ефимовна Сухарева) (1891 – 1981)
If you read just about any book on autism, you will invariably learn that Leo Kanner discovered autism, and that Hans Asperger further refined diagnostic criteria into functional categories that would lead to autism being later defined as a spectrum. Whilst it is true that Kanner and Asperger worked in the field of what we now call autism spectrum disorders, it’s not at all true that they discovered or pioneered the work. Those titles belong to Dr. Grunya Efimovna Sukhareva.
Indeed, Steve Silberman’s Neurotribes perpetuates the myth in it’s forward that autism began with Kanner and Aspterger.
Steve’s journalistic instincts and skills led him to do a tremendous amount of research, illuminating as no one has before the history of Leo Kanner and Hans Asperger and their clinics, as well as those who followed.
One can’t simply assign ignorance to Dr. Sacks in his glowing forward. A tremendous amount of research? The history of autism began with Kanner and Asperger? Yet, Silberman the journalist, repeats the fable in the opening pages.
To put the rising numbers in context, I familiarized myself with the basic time line of autism history, learning the story of how this baffling condition was first discovered in 1943 by a child psychiatrist named Leo Kanner, who noticed that eleven of his young patients seemed to inhabit private worlds, ignoring the people around them.
There’s a trend in society that folx should “educate themselves” on issues of importance.” Unfortunately, when it comes to autism, people read books like Neurotribes and consider themselves educated. They don’t realize that much of the narratives in books like Neurotribes simply retell the myths generated out of the eugenics-dominated past, often going so far as to sanitize the work of those who participated in the Nazi’s race hygiene programs (like Asperger). This is the problem that happens when people outside of a culture seek to frame what that culture is.
Yes, I’ve read Neurotribes. To me, it’s a well constructed piece of inspiration porn. It’s myth building.
Even authors like Edith Sheffer, in her takedown of Asperger (Asperger’s Children: the origins of autism in Nazi Vienna), ignore the true history of autism. Sheffer is brutal, however, in her making the case for the direct link between Kanner and Asperger, and for Asperger’s willful participation in the extermination of those deemed unfit to serve the volk. In making her case, she lays the foundation that there was no way Asperger couldn’t have known about Sukhareva’s work. The medical community then was small, attended the same conferences, and published in / read the same journals published in a common language (German).
Thinking to do “a tremendous amount of research” ahead of writing my book, No Place for Autism?, I found that a simple search for the history of autism does yield some surprising results. Results which are publicly available and free to download and share. Here’s one that I found from the Nordic Journal of Psychiatry.
Manouilenko, I., & Bejerot, S. (2015). Sukhareva--Prior to Asperger and Kanner. Nordic journal of psychiatry, 69(6), 479–482. https://doi.org/10.3109/08039488.2015.1005022
Sukhareva's original article was published almost two decades prior to Asperger’s and Kanner’s work. Asperger’s descriptions — in fact much less so Kanner's — very closely resemble those of the children with“ schizoid personality” reported by Sukhareva. How much Kanner and Asperger actually knew of Sukhareva's early work remains unknown. Intriguingly, these three pioneers first to describe the clinical picture of autism, were all German speaking and born in Ukraine and Austria, but died within a brief time span of only 6 months as citizens of USA, Austria and the Soviet Union.
Being Jewish, a citizen of the Soviet Union and publishing in German and Russian, in addition to being a woman, may at the time not have been a successful formula for achieving international acclaim. However, Sukhareva is remembered locally; a commemorative article was recently published in Russian in honor of the 120th anniversary of her birth (21) but she deserves a wider recognition for her work.
Combining the above sentiment with Sheffer’s work, I would restate the last paragraph noted above. There’s no way that Asperger, a member of the German Labor Front (DAF), the National Socialist People’s Welfare Organization (NSV), and the National Socialist German Physicians’ League (NSDÄB), which was a lead “fighting organization” of the Nazi Party that sought to coordinate physicians according to party principles and was involved in the persecution of Jewish doctors, would cite a Jewish woman as the source of his work. No way at all.
So, having set the stage, I’ll bet you’re curious as to what Dr. Sukhareva wrote about autism. How detailed and accurate was she in her observations? Here is her list of traits from her original paper (1925 Russian / 1926 German).
Schizoid personality disorders of childhood, Sukhareva, examples:
An autistic attitude: Tendency toward solitude and avoidance of other people from early childhood onwards; avoids company with other children
Impulsive, odd behavior
Clowning, rhyming
Some were speaking endlessly or asking absurd questions of the people around them
Affective life flattened
Seems odd
A tendency toward abstraction and schematization (the introduction of
concrete concepts does not improve but rather impedes thought processes)
Lack of facial expressiveness and expressive movements
Mannerism; decreased postural tone; oddities and lack of modulation of speech
Superfluous movements and synkinesis
Nasal, hoarse or high pitched whining voice or lacking in modulation
Keep apart from their peers, avoid communal games and prefer fantastic stories and fairy tales
Find it hard to adapt to other children
Ridiculed by their peers and have low status
Tendency towards automatism: Sticking to tasks which had been started and psychic inflexibility with difficulty in adaptation to novelty
Tic-like behaviors
Grimacing
Stereotypic neologisms
Repetitive questioning; talking in stereotypic ways
Rapid or circumscribed speech
A tendency for obsessive-compulsive behavior
Lengthy preparation and difficulty stopping
Pedantic, follows principles
Emotional outbursts
If interrupted becomes agitated and starts the story all over again
Strong interests pursued exclusively
Preservative interests, e.g. conversation marked by repetitive obsessional themes; clings to certain themes
Tendency to rationalization and absurd rumination
Musically gifted- enhanced perception of pitch
Sensitivity to noise, seeks quietness
Sensitivity to smell
Onset in early childhood
Inability to attend normal school due to their odd behaviors
Intelligence normal or above normal
Note how detailed her criteria were. Remember, the original paper was published in 1925. The German translation was published to a wider audience in 1926. The DSM didn’t get this detailed on autism until DSM-V. Yet, there’s Dr. Sukhareva’s list.
You don’t have to read German or Russian to read what Dr. Sukhareva had to say today. For example, you can find the translation of her third article on the subject from 1930 online in the European Child and Adolescent Psychiatry Journal.
Doing your own homework, you’ll find that her first article, published in 1925, detailed the lives of several boys in her care. Her second article, published in 1927, focused on the lives of five adolescent girls. Her third article, published in 1930, sort of puts all these ideas together as a more cohesive whole. Again, these were all published and available to Kanner and Asperger well before they began their work. The English translations, all available online, certainly pre-date Neurotribes. So, again, why the ignorance?
The authors of the translation of the 1930 article include background information useful to contextualize this work historically, as well as commentary on some of the questions raised for the 'history of autism' by Sukhareva's work. Here’s the citation.
New, W.S., Kyuchukov, H. Sukhareva’s (1930) ‘Toward the problem of the structure and dynamics of children’s constitutional psychopathies (Schizoid forms)’: a translation with commentary. Eur Child Adolesc Psychiatry (2022). https://doi.org/10.1007/s00787-022-01948-1
Here are some select quotes from the author’s commentary.
Her paper, she states (27) at the outset', represents a methodological attempt to understand psychopathies differently than in our previous scientific work concerning child psychopathies. 'Her goal was to turn from a primarily nosological approach to analyzing the dynamics of separate forms of child psychopathies ... and to observe the ways in which psychopathological patterns take shape as children grow and encounter the social and domestic life that surrounds them'
Ernst Kretschmer … connected autism (as explicated by Bleuler) with the schizoid temperament, a formulation that Sukhareva referenced in her first paper: "Autism [of the psych-aesthetic type], regarded as a symptom of the schizoid temperament ... is predominantly a symptom of hypersensitivity. Such overexcitable schizoids feel all the harsh, strong colors and tones of everyday life ... as shrill, ugly, and unlovable, even to the extent of being psychically painful. Their autism is a painful cramping of the self into itself. They seek as far as possible to avoid and deaden all stimulation from the outside ... The autism of the predominantly an-aesthetic, on the other band, is unfeelingness, lack of affective resonance for the world about them, which has no interest for his emotional life, and for whose own rightful interests he has no feeling. He draws himself back into himself, because he has no reason to do anything else, because all that is about him can offer him nothing"
Sukhareva's article was published originally in Russian in 1925, and then in Berlin, in German, in 1926. Sukhareva presents her research-describing the cases of seven boys-as the first to detail schizoid personality disorder (psychopathy) in children. While she does not diagnose her patients as autistic per se, she does repeatedly note autism as a symptom-with reference to Kretschmer's typology-of schizoid personalities. Wolff [in her 1996 paper] focuses her attention on the similarity between Sukhareva's patients and those of Asperger, and asks how or why Asperger was not familiar with this article, which was published in a German journal.
I think we’ve already answered Wolff’s question above.
In Sukhareva’s 1927, 'The particular features of schizoid psychopathies in girls', translated from German by Charlotte Simmonds (2020), Sukhareva describes five adolescent girls fitting the diagnosis of schizoid psychopathy and living in the 'children's home' and attending the remedial school. Sukhareva notes here that fewer girls are diagnosed with this condition and that there are some significant differences between boys and girls. Differences between autistic girls and boys, as Simmonds and others have pointed out, and the under-identification of autistic girls and women, is an important topic in current autism research. That Asperger included no girls in his subject sample receives critical attention from Edith Sheffer.
… and these excerpts from her 1930 paper:
Within the framework of this research, we examined thirty-one subjects, among whom were eighteen boys and thirteen girls from the different social environments. Their age varied between eight and nineteen. The period of observations was from 5 to 7 years, and nineteen subjects had already gone through the puberty. We move now to the presentation of our data.
That’s a pretty good sample from which to gather data and form conclusions.
… parents cannot detect changes in the mental state of children at this age; however, at the same time, they complained that their children are extremely active or tremendously sluggish. But the psychomotor insufficiency of schizoids differs sharply from that which occurs in other preschoolers. For schizoid children, the bipolarity between excitement and laziness can be found at the early stage; moreover, the schizoid's anxious excitement is distinguished by its stereotypical character and pointlessness. He is not inclined to play games but will pathologically focus on a definite activity, resembling catatonic mobility (Katotonische Bewegungsdrang).
Some features are found especially early in schizoid girls: inadequacy of emotional reactions, quirkiness of emotional combinations, sharp ambivalence, etc. The typical intellectual features of schizoids (inclination towards abstraction, formality, quirkiness, and automatism of associations) are usually discovered later than the disorder of psychomotor skills, but already in preschool age absentmindedness, self-absorption, and an atypical orientation of interests often attracts attention. They do not play common games with other children, but rather invent their own games and play them alone; they are not interested in what is going on in the kindergarten. The eccentric tendencies of questionasking characteristic of children at this age often takes on a tinge of obsession in schizoid children. Moreover, their questions are often abstract in nature, and often have a hypochondlial element, manifesting a fear of death and a fear of life.
It quickly becomes apparent that Dr. Sukhareva’s descriptions from 1930 look similar to those found in modern journals. Yet those journals omit any mention of her work.
I could go on and on, but I hope that you get the point by now. Her three papers, published between 1925-1930, represent a vital piece of the history of autism and thus deserve the attention of anyone who is interested in autism. I share this with you to lend vital context to the discussion, as well as to give you some names and papers that will lead you down a line of inquiry that can help you decolonize your studies and knowledge base. Yes, you would be surprised how other cultures studied autism, and for what purpose. We don’t need to focus so much on sources from Nazi race-hygiene programs and eugenics-minded scholars.
I thank you for your time, as always. Feel free to comment below. Then, go share the good news with someone you love.